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I had a quick thought to share on Caster Semenya and the discussion around whether she has a performance advantage and should be allowed to run, assuming the reports of internal testes are correct.

A lot of the discussion revolves around whether Semenya will be banned. Politicians and officials have threatened World War III if this happens, and vowed that Semenya will continue to run regardless of her condition. Her supporters are saying that she should be allowed to run no matter what, while others are saying she should not run if she a enjoys a performance advantage as a result of the condition.

The reality is that there may never even need to be a decision, and any controversy around the issue may well be dealt with as a result of medical concerns taking precedence over performance concerns.

Having initially written this post on Saturday 12 Sep, I’ve learned a bit more, courtesy colleagues in pathology and from your comments, and so I’ve edited this post to improve its accuracy. Thanks as always for your time and comments!

The issue of what the IAAF should do regarding Semenya’s participation in sport may very well be completely irrelevant. That’s because, if the reports are true, and she has internal testes, then SHE would almost certainly have to seek medical treatment.

In cases like this, three options options often exist

Surgical removal of the testes, which is likely the recommended option. According to Alice Dreger, an expert on intersex conditions, “Women with testes are at risk of testicular cancer. So doctors typically recommend having them taken out and having women take hormone replacement therapy (to retain bone health)”. Thanks to Amby for that comment, as well.

Hormonal treatment and gender re-assignment. However, according to Dr Pete, a commenter in the post, this is very unlikely in the current scenario. It would require the correct internal anatomy and according to experts I’ve spoken to, is quite unlikely. Also, the testes would need to be removed anyway.

Do nothing. It is still possible Semenya chooses to do nothing (against medical advice). This is risky, because the danger of malignancy and cancer is substantially higher. Also, it’s more difficult to detect with internal testes, and so she’d need careful monitoring. Once again, from Alice Dreger: “But one option is leaving them in and using watchful waiting so far as cancer risk is concerned, and more and more women with AIS feel that is a reasonable option”

Of the three, I’d say 1 and 3 remain on the table.

So why might this make the argument over performance advantages and the IAAF irrelevant? Because this situation has by now become a HEALTH issue first, and a performance one second. If Semenya has surgery, then the source of the potential advantage – the testes and the testosterone – will no longer be present and she can compete without any question (obviously, provided the issue is cleared up, as for the IAAF policy on sex reassignment). The necessary medical intervention may eliminate any debate over whether she has complete Androgen Insensitivity Syndrome or a partial AIS, and how much the testosterone might be helping her.

So rather than ask what the IAAF will do about her performance advantage, one should perhaps be asking whether the medical treatment SHE seeks is going to affect performance, and whether that medical treatment might negate the responsibility of the IAAF to make a decision at all.

Of course, it’s possible that she chooses to do nothing, and then the ball is in the IAAF court once again, and they’d have to look at performance advantage. I’ll look at that in the future, for sure.

But here are the two scenarios:

She goes for surgery, has the testes removed. 2010 will bring one of two results:

She runs just as fast as in 2009, but should then not be questioned, since the “advantage” is no longer present.

She slows down, but should still not be doubted. Either way, there is no issue of a ‘ban’ because of a performance advantage.

In this case, the Minister of Sport, ASA and everyone else ‘threatening’ the IAAF don’t ever have to carry out their threats. In fact, the only way they would be able to stand their ground and occupy their current position is if they refuse to allow her to seek medical advice for a potentially life-threatening condition.

Meanwhile, those saying she should not run because of an advantage need not worry about the advantage. The medical concerns may well negate all the controversy.

Ross

This post is part of the following threads: Caster Semenya, News/Controversies – ongoing stories on this site. View the thread timelines for more context on this post.

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